Background
Methods
Recruitment
Interviews
-
Activities used in general practice pertaining to a healthy diet, physical activity, losing weight, stop smoking and reducing alcohol use
-
Origin of activities
-
Since when are activities carried out
-
Patient groups
-
Related costs
-
Changes in activities
-
Results / effects of activities
-
Barriers pertaining to the delivering of health promotion activities
-
Facilitators pertaining to the delivering of activities
-
Requirements/ fittings for the future
-
Attitude of GP/ PN pertaining to their role in health promotion
-
Knowledge and skills pertaining to carrying out health promotion activities
-
Attitude of GP/ PN pertaining to the patient’s responsibility
-
Balance between promotion of health and interfering in someone’s life
Data analysis
Results
Practice (N=17) | General practice (N=8)* | |
---|---|---|
Health care centre (N=8)** | ||
Therapeutic centre (N=1)*** | ||
Function (N=25) | GP (N=16) | PN (N=9) |
Gender (N=25) | GP Female (N=8) | PN Female (N=9) |
GP Male (N=8) | ||
Working status (N=25) | GP Part-time (N=6) | PN Part-time (N=8) |
GP Fulltime (N=10) | PN Fulltime (N=1) |
Health promotion activities in general practice
Actions among GPs an PNs (N=17) | Related patient groups | |
---|---|---|
Alcohol reduction
| Give advice (N= 17) | Alcoholics (N= 16) |
Give a referral to addiction treatment (N=15) | Diabetics (N=10) | |
Individual lifestyle counselling by GP (N=4) | Cardiovascular patients (N=9) | |
Stop smoking
| Give advice (N=17) | COPD patients (N=14) |
Individual lifestyle counselling by PN (N=15) | Diabetics (N=13) | |
Prescribe medication (N=13) | Cardiovascular N=12) | |
Promotion exercise
| Give advice (N=14) | COPD patients (N=12) |
Give a referral to exercise program physiotherapist (N=12) | Diabetics (N=11) | |
Refer to physiotherapist (individual) (N=10) | Cardiovascular patients (N=10) | |
Promotion healthy diet
| Give advice (N=16) | Overweight/ obese patients (N=15) |
Give a referral to dietician (N=15) | Cardiovascular patients (N=12) | |
Individual lifestyle counselling by PN (N=13) | Diabetics (N=10) | |
Losing weight
| Give advice (N=16) | Overweight/ obese patients (N=17) |
Give a referral to dietician and physiotherapist (N=13) | Diabetics (N=4) | |
Give a referral to surgeon (N=2) |
Barriers and facilitators experienced by GPs and PNs
PATIENT | GENERAL PRACTITIONER/ GENERAL PRACTICE | ATTITUDE GENENERAL PRACTITIONER | HEALTH PROMOTION PROGRAM | HEALTHCARE SYSTEM/ GOVERNMENT | |
---|---|---|---|---|---|
BARRIERS
| Lack of patients’ motivation to change unhealthy behaviour * | Results are difficult to measure | Patients do not appreciate it when GPs of PNs discuss their lifestyles | Lack of proven effectiveness of health promotion programs | The hours of PN are not fully compensated financially |
Unhealthy lifestyle is socially accepted, especially drinking alcohol | Lack of skills among GPs and PNs to discuss lifestyle and develop health promotion programs | Group sessions seems to be more effective compared with individual counselling, but most of the health promotion programs in general practice are individual | Lack of overview of health promotion programs | Lack of reimbursements and subsidies to start new health promotion programs in general practice | |
Patients deny or lie about their actual lifestyles | Lack of time among GPs to discuss lifestyle with patients and develop health promotion programs | GPs state discussing lifestyles is a waste of time | Lack of continuity of health promotion programs, due to short-term reimbursements and subsidies | GPs have to meet too many strict requirements of healthcare insurance companies, to receive reimbursement and subsidies (e.g. registration, accredited courses) | |
Patients are unaware of their unhealthy lifestyles | Dietician and addiction care consultant disappear due to lack of patients | Consultation hours are more focused on treatment instead of on prevention | Not all patients can be reached in general practice | Lack of trust among GPs and PN in reimbursement and subsidies due to continuous changes | |
Patients experience barriers to live a healthy lifestyle (e.g. co-morbidity, lack of time) | GPs do not give patients referrals and motivate their patients as much as they can | GPs are sceptical about the effects and results of discussing lifestyle | Programs are not accessible, due to narrow inclusion criteria and affordability of programs | Contradictory policy of Dutch government (e.g. expensive healthy food, inconsistent smoking policy) | |
Behavioural change is a complex process for patients, especially when the environment does not change | Due to unhealthy behaviour of GPs and PNs (especially alcohol use) it is difficult to discuss lifestyles with patients | GPs think lifestyle is not important | Lack of health promotion programs | GPs and patients have to find out reimbursement and subsidies from insurance companies themselves | |
Letting patients pay contribution for health promotion programs does not work, especially not among low SES patients | Motivation of GPs and PNs decrease due to disappointing results | Programs are not accessible for patients due to waiting lists | Lack of collaboration between hospital and general practices with regard to health promotion activities | ||
Due to stigma patients are not going to addiction care | Lack of collaboration between disciplines | Health promotion activities in general practice are not rewarded | |||
Patients do not go to health promotion programs due to geographical barriers (E.g. distance to program) | Lack of room and housing | Contradictory information from insurance company towards patients | |||
GPs forget to ask about lifestyles | |||||
FACILITATORS
| Patients who are aware of their own lifestyles and who are motivated to change their lifestyles is a motivation for GPs and PNs | Availability of PNs in general practice: he/she has more time than GPs and plays a central role | GPs thinks it is worthwhile to discuss lifestyle with patients | Health promotion programs in general practice are familiar for patients | Reimbursements and subsidies determine participation and development of health promotion programs |
Let patients do what they want to do; there is a bigger chance they will succeed | More collaboration and feedback due to availability of physiotherapist and dietician in general practice | GPs state it is part of their job to promote a healthy lifestyle | Easy accessible health promotion programs due to broad inclusion criteria and affordability | Umbrella of GP organization develop health promotion programs and clear policy | |
Patients are more motivated when they have insight in their results (e.g. blood sugar level) | Sufficient staff for developing and conducting lifestyle programs | GPs and PNs think they are skilled to discuss lifestyle with patients | Continuity of health promotion programs | ||
Patients are more motivated to participate in a lifestyle program when they have to pay contribution | Familiarity between patients and GP and PNs is an advantage to discuss lifestyle | Healthy lifestyle of GP and PNs is a role model for patient | Best way to discuss lifestyle is in an open manner, not by using a protocol | ||
Sufficient room and accommodation | Proven effectiveness of health promotion programs | ||||
Enthusiastic colleagues to develop and deliver lifestyle programs | Overview/ social map of disciplines and health promotion programs | ||||
Structured registration and labelling of patients at risk provide an overview for GPs | Availability and collaboration with sport facilities |
Attitude of GPs and PNs
IGNORER | ADVISER | CONFIRMER | EVANGELIST | INTERFERER | NURTURER | |
---|---|---|---|---|---|---|
VISION
| Limited role of GP pertaining to the promotion of a healthy lifestyle. It is the task of the government to promote a healthy lifestyle. Reimbursement is a strong motivational factor for the delivering of intervention in general practice. | Health promotion and prevention are part of the job of a GP. Although GPs state their consulting hours are more focused on treatment instead of prevention, they think it is worthwhile to spend time on health education and counselling. But in the end patients make their own choices. | Self management among patients is very important in general practice. The PN has a central role to educate and counsel patients. The GP confirms the importance of healthy lifestyle and supports progress of behaviour change of patients. | The general practice carries out a lot of lifestyle programs. However the GP is sometimes sceptical about the effects. Nevertheless, they are sure that they can help at least some patients. | GP discusses lifestyle even if the patient has no related symptoms. They confront their patients with their unhealthy lifestyle. These GPs have a lot of lifestyle programs in general practice. | The role of the GP is like the role of a teacher/ educator or nurturer. GP’s have to educate their patients. |
The GP imposes standards of a healthy lifestyle also to his/her own life, to set a good example. | ||||||
QUOTES
|
‘Those lifestyle interventions are not that important, in my opinion’.
|
‘Yes, eventually the patient is responsible; however as a GP I can provide patients with information’.
|
‘The plans for behaviour change are made between patient and PN (…). Our role is just to support and consolidate this. Even if they come with a cold, I say ‘You want to lose some weight. Well done!’
|
‘You want to create an atmosphere in which you radiate that and eventually it works somehow. Even if it is for later generations’.
|
‘If you see cigarettes in the patients’ breast pocket, do you have to say something about it or not? (.) If I am well acquainted with the patient, I do’.
|
‘You have to raise your patients and teach them how to deal with health in their life’.
|
‘I can improve very little at the individual level’.
| ||||||
‘Patients are doing a lot of simple primitive things wrong (…) I may discuss that with my patients’.
| ||||||
‘I think I am a health adviser’.
| ||||||
‘You must go on. On the one hand because there are (minimal) results and on the other hand because it is professional motivation. It is like ‘Médecins Sans Frontières’ an (international humanitarian organization); they go to a warzone, yes… and later on there is a new front. Shouldn’t they have gone out and help over there? You have to do something. You will help at least some individuals’.
| ||||||
‘I put all of them (fat ladies, WG.) on a weighing scale and I say: What do you think of it? (…) It’s a wakeup call. They don’t like it, but it has to be done, right?’
| ||||||
‘I think it makes sense to tackle bad lifestyle habits in order to prevent. And that we can say: well if you are not stupid, you have to get smart’.
| ||||||
‘I would never discuss the importance of exercise etcetera if there is no policy on a national or regional level’.
|
‘Advisory, not mandatory. I give advice and patients can do with it what they want. It is their responsibility’.
| |||||
‘We try to motivate patients, using the power of repetition and the fact we are a team’.
| ||||||
‘Sometimes I lay my hand on one of those pot bellies and say: When is the baby coming?’
| ||||||
‘I will change my working method if the insurance company offers me a reimbursement’.
|